Provider Demographics
NPI:1528219714
Name:BAINE, JENNIFER G (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:G
Last Name:BAINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 HILLBROOK LN NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3208
Mailing Address - Country:US
Mailing Address - Phone:832-724-5696
Mailing Address - Fax:
Practice Address - Street 1:4929 HILLBROOK LN NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3208
Practice Address - Country:US
Practice Address - Phone:832-724-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109073207P00000X, 207PS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program